Chronic care management: Docs say hassles trump rewards

Despite providers' enthusiasm for the potential to get paid for non-face-to-face care-coordination activities, participation in formal chronic care management (CCM) has thus far proven to be too cumbersome for many to be worthwhile.

Medicare's new CCM code--99490--is especially onerous, according to several doctors who spoke with Medpage Today. Challenges to using the code include adding infrastructure, timing clinician activities and persuading beneficiaries the program is worth an $8 per month copay, FiercePracticeManagement reported previously.

"One of the hard things is finding a way to explain this to patients," said Robert Wergin, M.D., president of the American Academy of Family Physicians, which pushed for Medicare to approve the code. "And on the business side, how do you justify the infrastructure you need to be in compliance?" Of family medicine practices surveyed last year, about 28 percent did not have a certified electronic health record, he noted.

That's not to say success stories do not exist. Samuel Church, M.D., a family physician in rural Hiawassee, Georgia, for example, said that CCM services such as a monthly phone check-in with patients can reduce the need for more visits while making patients feel well-attended. As of early June, Church had signed up 300 of the 1,300 Medicare beneficiaries in his practice with two or more chronic conditions, he told MedPage, with a goal to add the rest.

Nonetheless, private payers who have followed Medicare's lead and adopted CCM programs of their own have also reported difficulty in getting clinicians and their patients to participate, according to a survey published in the American Journal of Managed Care. Key barriers reported by health plans included limited patient engagement, inadequate provider resources and provider reluctance to change.

Providers' resistance to shifting from encounter-based care to population health management has more to do with "tradition and habits" than reimbursement, Soeren Mattke, M.D., the study's lead author and a senior scientist with the RAND Corporation, the sponsor of the study, told Medical Economics, adding that management-based programs can often reap better financial rewards than the old approach.

To learn more:
- read the article from Medpage
- see the story from Medical Economics
- here's the study from the American Journal of Managed Care